Correlation between immunization status and pediatric diphtheria patients outcomes in the Sampang District, 2011-2015

Abstract

Background The number of diphtheria cases recently increased, such that an outbreak was declared in East Java Province, which includes the Sampang District. Immunization completion status is a determining factor for diptheria infection.
 Objective To investigate for correlations between immunization status and outcomes (severity level, fatality, and complications) of diphtheria patients in the Sampang District.
 Methods This analytic, cross-sectional study used secondary data from the East Java Provincial Health Office on diphteria patients aged 0-20 years during the 2011-2015 outbreak in the Sampang District and interviews with diphtheria patients in that region. The Diphtheria Research Team of Soetomo Hospital collected data on immunization status, diphtheria severity (mild, moderate, or severe), case fatality (died or survived), and complications in the patients (with or without complications). Spearman’s, Chi-square, and Fisher’s exact tests were used for data analyses, accordingly.
 Results Seventy-one patients with clinical diphtheria were identified, 17 of whom were confirmed with positive culture results. The case fatality rates were 7% in patients with clinical and 5.9% in confirmed diphtheria. There were no correlations between patient immunization status and severity (P=0.469 clinical, P=0.610 confirmed), or fatality (P=0.618 clinical, P=0.294 confirmed) of diphtheria in the clinical and confirmed diphtheria patients. However, there was a correlation between patient immunization status and the emergence of complications in clinical (P=0.013), but not in confirmed (P=0.620) diphtheria patients.
 Conclusion There is a correlation between immunization status and complications in clinical diphtheria patients. Such a correlation is not found in confirmed diphtheria cases because none of the patients had complete immunization status.

Profile of Diphtheria Cases Hospitalized at Tertiary Referral Hospital in Indonesia

“…5,8 In this study, diphtheria occurred mostly in early childhood years (9 years and below) due to inadequate immune system performance. School-age children have increased frequency of contact with the disease-causing pathogen.. 9 In our study, male predominance was found in 20 cases (58.8%), a similar result to a study conducted at Gujarat in 2013 which also found male predominance (63%). 4 In this study, all cases were presented with pseudomembrane that were found most in pharynx (23 cases, 67.6%) and tonsil (21 cases, 61.8%).…”

Risk factors for diphtheria outbreak in children aged 1-10 years in East Kalimantan Province, Indonesia

“…The results of this study complement the findings of Dhinata et al . 19 , which found no correlation between patient immunization status and severity, or fatality of diphtheria in the Sampang District of Indonesia.…”

Hubungan Status Imunisasi dengan Kejadian Difteri Berat pada Pasien Anak yang Dirawat di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung Periode Januari 2015 – Juli 2019

“…6 Berdasarkan penelitian sebelumnya, komplikasi difteri terjadi pada 26 dari 71 penderita difteri atau 36,6%. 7 Komplikasi penyakit difteri pada pasien dengan bull neck, gangguan pada jantung, saluran pernapasan, ginjal, ataupun saraf berisiko menyebabkan kematian. 8 Di Indonesia, terdapat 24 kasus pasien difteri meninggal pada tahun 2016 (CFR difteri 5,8%), 13 kejadian di antaranya ada di Jawa Barat (CFR difteri 9,78%).…”

“…Namun, pada penelitian tersebut ditemukan bahwa pasien difteri dengan status imunisasi lengkap mengalami difteri yang ringan dan tingkat fatalitas lebih rendah dibandingkan pasien dengan status imunisasi tidak lengkap atau tidak imunisasi, walaupun hasil tersebut tidak bermakna secara statistik. 7 Penelitian ini memiliki asosiasi dengan penelitian pada pasien difteri dewasa oleh Pantukosit dkk 16 di Buri Ram, Thailand. Pantukosit dkk melaporkan bahwa imunisasi tidak lengkap akan meningkatkan risiko komplikasi pada pasien difteri, insiden komplikasi merupakan indikator dalam penggolongan difteri berat.…”